Montana State University

Office of Human Resources

Montana State University
P.O. Box 172520
Bozeman, MT 59717-2520

Tel: (406) 994-3651
Fax: (406) 994-5974
E-mail: humanresources@montana.edu

Office:
920 Technology Blvd. Suite A Bozeman, MT 59718-4001
Service Center:
Montana Hall, Room 18

Chief Human Resource Officer

Dennis Defa

Health Benefits for Employees


Below are links to forms and websites to help you answer your benefits questions. For additional assistance please contact Human Resources at 994-3651.

CHOICES Forms

FY14 CHOICES (2013-2014)

Summary of Benefits and Coverage
CHOICES Blue Cross Managed Care
CHOICES Allegiance Managed Care
CHOICES Pacific Source Managed Care
CHOICES Traditional Coverage

CHOICES FY14 Workbook
CHOICES FY14 Enrollment Form
CHOICES Retiree Enrollment Form
CHOICES Retiree Workbook
CHOICES Active Employee Mid-Year Change (Not Available)
COBRA Enrollment Form (Not Available)
MAPP Enrollment Form (Not Available)

FY13 (2012-2013)

CHOICES Workbook
CHOICES Enrollment Form
CHOICES Retiree Enrollment Form
CHOICES Retiree Workbook
CHOICES Active Employee Mid-Year Change
COBRA Enrollment Form
MAPP Enrollment Form

General

Adult Dependent
Allegiance Authorization to Release Confidential Information
Allegiance Medical Claim Form
Allegiance Physician's Statement of Disability
Alternate ID Form
Benefit Providers Contact Information
Blue Cross Blue Shield International Claim Form
Change in Beneficiary
Prescription Reimbursement Form
EyeMed Out of Network Claim Form
Ridgeway Enrollment Form
Family Medical Leave Form
Family Medical Leave Fact Sheet
Montana Medical Care Savings Account

CHOICES Informational Links

Allegiance Card Instructions (How to Read)
Allegiance Website Guide for Employees
Accidental Death & Dismemberment booklet
Employee Benefit Resources Summary Plan
Group Benefits Plan Book - Indemnity
Group Benefits Plan Book - Managed Care
Health Care & Dependent Care Spending Accounts
Healthy Montana Kids
MEDEX Travel Assist
MSU Benefits Committee
Standard Additional Life Insurance Information
Standard Life & Disability Information
Standard Travel Benefit Brochure
Standard Travel Benefit Brochure (Ex pat-over 90 days)
Standard Travel Benefit Form (Ex pat-over 90 days)
Summary Plan Description

Flexible Spending Accounts - Peak1 (FY 12-13)

Flexible Spending Account Enrollment Form
Dependent Care FSA Reimbursement Form
FSA Peak1 Debit Card Enrollment Form
FSA Peak1 Reimbursement Form
FSA Peak1 Direct Deposit Form

Peak1 Portal Quick Start Guide
FSA Eligible and Ineligible Expenses

Flexible Spending Accounts - Allegiance (FY13-14)

Adoption Assistance Form
Adoption Assistance Program
Day Care Reimbursement contract
Debit Card Enrollment Form
Direct Deposit Form
Dependent Care Reimbursement Form
FSA Medical Reimbursement Form

Informational Websites

Allegiance
Allegiance Flex Advantage
Blue Cross Blue Shield
CHOICES Website
Employee Assistance Program
Eye Med
Managed Care Program
Medex
Military Family Leave
Montana University System (MUS)
MUS Benefits Committee Members
New West Health Services - Retirees Only
Peak1
Ridgeway Pharmacy
Self Audit Program
Standard Life Insurance
TLC (The Life Connection)
UNUM Long Term Care Insurance
MSU Wellness
Wellbaby

URx - Prescription Drug Plan

URx Website
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